When and How to Find a New Therapist

You’ve been seeing a therapist for a while and you’re beginning to wonder: Shouldn’t I be feeling better? Here are tips to know whether your therapy for depression is working or if it’s time to find a therapist better suited to your needs...

Do you have this nagging sense that your therapy for depression isn’t working? That you need to find a new therapist?

If so, you’re in good company.

About 1.5% of all U.S. women receive therapy for depression each year, according to a Philadelphia VA Medical Center study published in Archives of General Psychiatry. Yet the first therapy attempt is completely successful only one-third of the time, according to the National Institute of Mental Health.

Patients need a sense of safety, comfort and trust in their depression treatment, explains Jon Allen, PhD, senior staff psychologist at the Menninger Clinic in Houston.

Research shows that the patient-therapist relationship is key when treating depression, he says.

“The chemistry in any relationship is crucial – and that includes the relationship with your therapist,” Allen says.

Ideally, you should feel comfortable talking with your therapist about anything – even whether it might be time to try a new approach or another therapist, he says.

You’ve been seeing a therapist for a while and you’re beginning to wonder: Shouldn’t I be feeling better? Here are tips to know whether your therapy for depression is working or if it’s time to find a therapist better suited to your needs...

Switching psychotherapists is no different than changing medications if the first one you try isn’t effective for you.

“Therapists and patients are too reluctant to switch when you’re not making progress,” Allen says. “My attitude is: If a patient is complaining about the therapy, there’s something very real going on that needs to be discussed.”

If your therapist gets defensive, that’s a warning sign, because a good one won’t take it personally, he adds.

In fact, if you both decide that changing psychotherapists is the best step, your current therapist may even be able to recommend a colleague whose style better matches yours.

Here are four signs that your therapy for depression isn’t working, and what you can do about it:

1. You Don’t Improve in Depression TherapyFirst, be patient, advises Aparna Sharma, MD, a professor and psychiatrist at Loyola University Medical Center in Chicago.

You didn’t get clinically depressed overnight, so don’t expect therapy to work that fast either, she says.

You’ve been seeing a therapist for a while and you’re beginning to wonder: Shouldn’t I be feeling better? Here are tips to know whether your therapy for depression is working or if it’s time to find a therapist better suited to your needs...

You should feel at least moderate improvement within 4-8 weeks after beginning therapy, according to the American Psychiatric Association. If not, make your therapist aware that you aren’t feeling better.

“Sit down with your therapist and go through that list of goals you went into therapy with,” Dr. Sharma says.

Discuss what can be done to help you progress, such as adjusting your depression treatment, she advises. That could mean scheduling more frequent visits, trying a different therapy approach or adding an antidepressant.

“Medication may bring some energy and relief,” says psychologist Sharon Anderson, PhD, a professor at Colorado State University in Fort Collins. “Then you may be better able to do some good work with your psychotherapist.”

If you’re already taking medication as therapy for depression, your psychiatrist or doctor might increase the dose, switch to a different drug or add a second medication.

If your therapist asked you to keep a daily log or take periodic questionnaires, look back at these to assess your symptoms.

“Also, ask for feedback from your significant other or close friends,” Anderson advises. “Are they seeing any difference in how you act in certain situations?”

They may say that you’re doing better than you thought.

You’ve been seeing a therapist for a while and you’re beginning to wonder: Shouldn’t I be feeling better? Here are tips to know whether your therapy for depression is working or if it’s time to find a therapist better suited to your needs...

2. You Don’t Like Your Therapist“[Most] of the effectiveness of therapy lies in the relationship between the therapist and patient,” Dr. Sharma explains.

It’s only natural that you’ll click with some psychotherapists more easily than others. If you dislike one right off the bat, move on to someone else.

But if you initially had good rapport with your therapist, and suddenly feel otherwise, your feelings might stem from your reluctance to deal with something that has come up in therapy, Dr. Sharma says.

Your discomfort, for example, might be caused by emotionally charged memories that had been suppressed but are now bubbling to the surface. Or negative patterns from other relationships that may affect your relationship with your therapist.

“For example, if you feel that your partner isn’t attuned, attentive and responsive enough to your needs at home, and your therapist is somewhat reserved, you might interpret that as being disengaged,” Allen explains.

Such ethical violations are clear-cut and uncommon. In an often-cited 2003 Illinois State University survey answered anonymously by 368 psychologists, 2% admitted that they had crossed a sexual boundary with a client.

In that case, you could file a complaint, Anderson says.

“You can contact the regulatory board that licenses or regulates practice [of that mental health profession] in your state,” she notes. “And if the therapist is a member of a professional association, you can contact [its] ethics committee.”

You’ve been seeing a therapist for a while and you’re beginning to wonder: Shouldn’t I be feeling better? Here are tips to know whether your therapy for depression is working or if it’s time to find a therapist better suited to your needs...

Other boundaries are fuzzier. For example, is it unethical when your therapist suggests socializing outside the office?

It depends, according to the American Psychological Association’s (APA) code of conduct: It’s unethical for a psychologist to have both a professional and personal relationship with a client only if it can “reasonably be expected to cause impairment or risk exploitation or harm.”

4. You’ve Hit a Plateau in Your Therapy for DepressionIt’s frustrating when therapy seems to be sailing along smoothly – and then you stall.

That’s again a signal to raise the issue with your therapist.

“Decide how long you’ll keep trying this before reassessing whether it makes sense to continue,” Anderson says.

Some patients are reluctant to express concerns, Allen says.

“This could come from relationships where they were dismissed, punished or squashed if they spoke up about dissatisfaction,” he says.

A therapist, however, should understand that it’s nothing personal. In fact, “the therapist should take you seriously and not put the problem all back on you,” Allen says.

People with treatment-resistant depression may need to try different approaches before finding one that works; for example, combining therapy with medication, according to the APA.

You’ve been seeing a therapist for a while and you’re beginning to wonder: Shouldn’t I be feeling better? Here are tips to know whether your therapy for depression is working or if it’s time to find a therapist better suited to your needs...

Find Your Perfect Psychotherapist and Therapy for DepressionIf you decide to move on, how do you find a therapist you click with or different approach?

First, seek referrals from physicians and trusted friends, Allen advises. Then interview two or three candidates to find the best match.

“It seems commonsensical to shop for a therapist – just like people who are considering surgery get a second opinion,” he says.

Several types of therapy are used to treat depression. These three are among the most effective, according to the APA:

1. Cognitive-behavioral therapy (CBT) focuses on changing self-defeating thoughts as well as learning helpful behaviors, such as activity planning.

2. Interpersonal therapy (IPT) focuses on relationship issues, such as conflict, loss, loneliness and role changes.

This might help people whose depression was triggered by a relationship problem, such as divorce or a continuing conflict with a co-worker.

You’ve been seeing a therapist for a while and you’re beginning to wonder: Shouldn’t I be feeling better? Here are tips to know whether your therapy for depression is working or if it’s time to find a therapist better suited to your needs...

3. Psychodynamic therapy stresses how past events shape current experiences and helps patients gain insight into underlying emotional conflicts. It’s a popular therapy for depression, but evidence for its effectiveness is weaker than the others.

It might benefit those who want to delve into their depression’s roots, Dr. Gladding says. However, depression treatment may several months or a few years, compared with a few months for CBT or IPT.

Get Off to a Strong StartBefore your initial therapy visit, consider what you want to get out of it.

“By the end of your first appointment, the therapist should know your [depression] treatment goals,” Dr. Gladding says.

If the therapist doesn’t bring up the subject, you should.

“The therapist might not be able to tell you exactly how many visits you’ll need;” that depends on the individual, Dr. Sharma says.

“But you should have an idea of whether it’ll be a short- or long-term process,” she says.

You’ve been seeing a therapist for a while and you’re beginning to wonder: Shouldn’t I be feeling better? Here are tips to know whether your therapy for depression is working or if it’s time to find a therapist better suited to your needs...

Bring It to a Happy CloseWhether your therapy for depression takes a month or year, it should steadily advance toward the day when you’ll say goodbye.

“Ultimately, the goal of a therapist is not to be needed anymore,” Anderson says.

It’s time to say farewell, when “a patient can really think for herself, be open to seeing problems and creative about finding solutions,” Allen says.

If you feel you’re ready to move on but your therapist disagrees, talk it over. Your therapist may see an issue that you don’t.

“Or you may decide to taper off gradually, going from weekly visits to every couple of weeks or once a month,” Dr. Gladding says.

When you leave, don’t slam the door behind you.

“Say to your therapist, ‘I’m good, but I’ll call you if I need to come in again,’” she says.

Then don’t be embarrassed to do so, Dr. Gladding says.

“There’s nothing wrong with returning for the occasional spot treatment,” she says.

You’ve been seeing a therapist for a while and you’re beginning to wonder: Shouldn’t I be feeling better? Here are tips to know whether your therapy for depression is working or if it’s time to find a therapist better suited to your needs...

How Much Do You Know About Depression?Despite all the progress in diagnosing and treating depression, many people still are in the dark. How much do you really know? Take this depression quiz, which includes information from Treating The Aching Heart, by Lawson Wulsin, MD

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